I’m Dr. Horacio Padua. I’m the clinical director of interventional radiology here at Children’s Hospital Boston. I did my fellowship here, so this is now my tenth year at Children’s, and I’m also a faculty member of the Vascular Anomalies Center here.
How did you become interested in this pediatric population?
When I did my fellowship, we were involved with doing the interventional treatments of vascular anomalies right from the get-go. My involvement at the start probably wasn’t as much as some other people but as you continue to do them and continue to be involved with the patients, continue to analyze and study these things, it’s hard not to get wrapped up in it, and you end up getting more and more involved with it. Certainly, if you asked me ten years ago, if I be doing this much vascular anomalies work, I would have said no, but now it probably comprises at least 40-50% of what I do.
Is there a particular anomaly or group of anomalies that you specialize in?
My particular focus is in the low-flow lesions: the lymphatic malformations and the venous malformations. I probably tend not to go toward the high-flow lesions which are the arteriovenous malformations. Occasionally I’ll be involved with the hemangiomas, the vascular masses that we look at. The interventional radiologists are part of the Vascular Anomalies Clinic, we see these lesions all together, so we’re not only involved in the diagnosis but occasionally you have to do some vascular interventions with these hemangiomas. But my predominant work is with the low-flow lesions, lymphatic and venous lesions.
What are some of the challenges of working with this population?
The challenges are that a lot of patients who have been through the ringer are more prone to wanting a quick fix for these things, and it’s hard to try to direct the patient to, “Okay, we can do this, we can do this without surgery, but it’s going to take a while, it may take months to years to try to get this thing fully under control. What I can be pretty confident saying is that after several, several treatments, more than likely we will get control of this thing, and you may get to a point where you don’t see me for five, six years, but you need to stay with me on this ride until we know we’ve got good control of this thing.” And that’s what we’re trying to do, getting good control without having to have a surgeon put a knife in you to try and do that. And that’s the most challenging thing with what I do because what I do is definitely not an instant fix.
What are some of the rewards of working with this population?
The best reward for this is you’ll usually get patients who have been strung through the medical system with no satisfaction in terms of diagnosis, the answers and the information they’re getting, let alone the treatments that they may be receiving. When they finally get to me, it’s very satisfying to now be able to at least point a family in what I consider the right direction. You see the relief in the families, especially when they show up in the Friday clinic saying, “We’ve been everywhere, and we feel so gratified now that we got here and people can really confidently tell us information that we can feel comfortable with based on experience of multiple disciplines and multiple people.” At an average clinic visit, you’ll get seen by at least four or five doctors that day, all that have experience in your particular disease. If a new patient comes to us, it’s certainly very gratifying to treat these things without having to get a knife involved, particularly when you’re dealing with children; you don’t want to leave them with surgical scars right off the bat. Probably the most gratifying ones are the big neck lymphatic malformations in babies that I treat. It can be quite disfiguring at birth and very anxiety provoking for a mother or a parent. When you can get that thing to go down to nothing just with needle injections, that’s very, very gratifying, to be able to tell a family, “No, your child doesn’t have to have a major neck operation. We can do this, you come in, we’ll do that in one day, maybe two to three treatments, and you’ll essentially have long-term control of your malformation.”